Is there potential for the future provision of triage services in community pharmacy?

Abstract

BackgroundWorldwide the demands on emergency and primary health care services are increasing. General practitioners and accident and emergency departments are often used unnecessarily for the treatment of minor ailments. Community pharmacy is often the first port of call for patients in the provision of advice on minor ailments, advising the patient on treatment or referring the patient to an appropriate health professional when necessary. The potential for community pharmacists to act as providers of triage services has started to be recognised, and community pharmacy triage services (CPTS) are emerging in a number of countries. This review aimed to explore whether key components of triage services can be identified in the literature surrounding community pharmacy, to explore the evidence for the feasibility of implementing CPTS and to evaluate the evidence for the appropriateness of such services.MethodsSystematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases from 1980 to March 2016.ResultsKey elements of community pharmacy triage were identified in 37 studies, which were included in the review. When a guideline or protocol was used, accuracy in identifying the presenting condition was high, with concordance rates ranging from 70 % to 97.6 % between the pharmacist and a medical expert. However, when guidelines and protocols were not used, often questioning was deemed insufficient. Where other health professionals had reviewed decisions made by pharmacists and their staff, e.g. around advice and referral, the decisions were considered to be appropriate in the majority of cases. Authors of the included studies provided recommendations for improving these services, including use of guidelines/protocols, education and staff training, documentation, improving communication between health professional groups and consideration of privacy and confidentiality.ConclusionWhilst few studies had specifically trialled triage services, results from this review indicate that a CPTS is feasible and appropriate, and has the potential to reduce the burden on other healthcare services. Questions still remain on issues such as ensuring the consistency of the service, whether all pharmacies could provide this service and who will fund the service.

Extending the scope of community pharmacists’ practice to patients requiring urgent care – An evaluation of a training programme using the Theoretical Domains Framework

“…Recent proposals to transform urgent and emergency healthcare services include using community pharmacies as an alternative provider to higher cost, out of hours and emergency departments (Curley et al., ; NHS England, ). Community pharmacy already provides a range of commissioned clinical services that contribute to improved patient outcomes, are effective (in terms of process measures), cost‐effective (when comparing the cost of community pharmacy with other providers) (Murray, ; Watson et al., ; Wright, ) and offer direct savings in terms of other health services avoided (such as GP and emergency department visits) (Ramalho de Oliveira, Brummel, & Miller, ).…”

“…Community pharmacy already provides a range of commissioned clinical services that contribute to improved patient outcomes, are effective (in terms of process measures), cost‐effective (when comparing the cost of community pharmacy with other providers) (Murray, ; Watson et al., ; Wright, ) and offer direct savings in terms of other health services avoided (such as GP and emergency department visits) (Ramalho de Oliveira, Brummel, & Miller, ). Recent estimates that community pharmacy could safely treat more than 10% of general practice and 5% of emergency department consultations (Fielding et al., ), at a substantially lower cost (Baqir, Learoyd, Sim, & Todd, ; Watson et al., ), and growing evidence that pharmacies can feasibly and appropriately improve access to treatment in particular for low‐income groups (Rafferty, Yaghoubi, Taylor, & Farag, ), suggest that community pharmacies have a place in the healthcare system for providing primary healthcare for certain common, self‐limiting or uncomplicated conditions efficiently and at scale (Bell, Dziekan, Pollack, & Mahachai, ; Curley et al., ; Watson et al., ), although uptake of services remains low and suggests that lack of awareness among patients may restrict the impact on health systems of community pharmacy services (Eades, Ferguson, & O'Carroll, ; Saramunee et al., ).…”

Privacy Level in Private Community Pharmacies in Saudi Arabia: A Simulated Client Survey

“…The issue of privacy maintenance at community pharmacies is a global one, since, worldwide, patients tend to seek advice from their community pharmacists regarding various treatments and minor ailments [14]. For example, although [15].…”

Starz-Drp: A Structured Framework for Teaching Community Pharmacists to Counsel Self-Care Customers

“…Such events are illustrated as a triage action plan [9]. Making a triage action plan is a distinctive service that CPs should execute in community pharmacy settings as it has potential to bring advantage to individuals who determine to self-medicate [10].…”